When you think of emergency first responders, you might not picture your aunt, accountant or pizza delivery guy. But at a White House meeting Feb. 10, more than 40 government officials and medical leaders -- including two AAFP representatives -- met to discuss how to best arm these bystanders and others like them to help during an emergency until medical professionals arrive.
During a physicians roundtable titled "Bystanders: Our Nation's Immediate Responders," Academy President Robert Wergin, M.D., of Milford, Neb., and Julie Wood, M.D., AAFP vice president of health of the public and science and interprofessional activities, offered suggestions on how family physicians could help spread this preparedness message.
Roundtable participants specifically focused on creating a campaign to teach bystanders how to quickly stop bleeding by using direct wound pressure and tourniquets, according to Wergin. Family physicians can play an integral role in spreading this information to their patients, he noted.
"As family physicians, our patients look at us as health care information sources," Wergin told AAFP News. "As this program develops, we'll inform members about the campaign and then ask family physicians to disseminate the information out to the public."
- During a Feb. 10 White House physicians roundtable, government officials and medical leaders met to discuss how to best arm bystanders to help during a medical emergency, particularly by stopping life-threatening bleeding.
- Among those invited to participate were AAFP President Robert Wergin, M.D., and Julie Wood, M.D., AAFP vice president of health of the public and science and interprofessional activities.
- The group discussed creating bleeding control kits that would include tourniquets and pressure dressings for public use that could be placed in federal buildings and heavily populated public areas.
In addition to educating the general public about bleeding control after an individual injury or mass casualty event, some at the White House event floated the idea of creating bleeding control kits that would include tourniquets and pressure dressings for public use. The kits could be staged in federal buildings and heavily populated public areas, much as automated external defibrillator kits are now.
It was at this point that Wergin said he suggested that education efforts focus primarily on applying pressure to a wound, because tourniquets would not be available at every incident.
Participants also discussed barriers to bystanders taking action during an emergency, such as insufficient knowledge, fear of injury to self, and fear of harming the victim and related liability.
A key component of the vision for the initiative is to develop and promulgate a phrase "that will help save lives and build resilience in the event of immediate life-threating illnesses or injuries, with focus on bleeding." Such a phrase, said Wergin, would be in the vein of past memorable national campaign slogans such as "stop, drop and roll" or "see something, say something."
One participant described how U.S. military techniques for stopping bleeding during combat have translated to successful civilian efforts to save lives during mass casualty events such as the Boston Marathon bombing in 2013. U.S. Air Force Col. Todd Rasmussen, M.D., presented an article(jama.jamanetwork.com) he co-authored that was published in the Journal of the American Medical Association in 2013, in which he described how bystanders significantly lowered mortality rates in Boston using lessons they learned while on active duty in Afghanistan and Iraq.
Rasmussen, who is director of the U.S. Combat Casualty Care Research Program, cited military research that found about 25 percent of people who die from explosive or gunshot wounds had potentially survivable injuries. Combat casualty care occurs in three phases, he stressed: at the point of injury, during transport to the hospital and while at the hospital. Effectively coordinating care delivered at each of these three phases can significantly improve survival.
Firsthand First Responder Experience
Wergin brings a unique perspective to this topic, thanks to his work as medical director of the volunteer fire department in his rural Nebraska hometown, as well as his service as Seward County medical liaison to the Federal Emergency Management Agency.
In his rural community, said Wergin, farmers and industrial workers could really benefit from education to stop bleeding and resources such as bleeding control kits, because many workers in these fields use machinery that can cause serious and even life-threatening injuries that simple first aid kits can't begin to touch.
Every community needs to prepare for emergencies and disasters such as earthquakes, tornadoes, pandemic influenza, disease outbreaks and terrorist attacks, Wergin added. Preparedness calls for identifying available resources and establishing relationships with both health care personnel and nonmedical professionals such as morticians. To that end, he recommended the AAFP's resources on emergency preparedness as a starting point for family doctors.
During the roundtable, Wergin said, the group discussed starting the outreach about being active bystanders and learning to control bleeding with children and adolescents, because adults aren't always around to help. And even when adults are available, children might still need to lead lifesaving measures.
Wergin recounted the experience of his son Brett, who was in eighth grade when a friend of his started choking in class and the teacher in the room froze up and was unable to help. Brett remembered what to do in such situations from a Red Cross class he had taken. He got into position and performed the Heimlich maneuver, saving his friend's life.